Scottish Pre-School Vision Screening – First 3 Years of National Data

Pentland, Lee; Patel, Sirjhun

doi:10.22599/bioj.138

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…[12][13][14] It is often assumed that highly skilled VA screening is more expensive, 5 but these data suggest that it is not necessarily the case. The current UKNSC recommendation to not specifically test for strabismus, as is carried out in many countries 11,15 seems supported. All children with significant newly diagnosed strabismus also had reduced VA.…”

Section: Discussionmentioning

confidence: 99%

Costs and effectiveness of two models of school-entry visual acuity screening in the UK

et al. 2021

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Cost effectiveness of different visual screening modalities cannot be calculated without long-term outcome data. This paper reports detailed outcomes from a gold-standard UK recommended orthoptist-delivered screening (ODS) at 4-5 years in school, compared to a neighboring schoolnurse delivered screening (SNDS), both feeding into the same treatment pathway. The target condition was reduced visual acuity (VA) of worse than logMAR 0.2 in either eye.Available records from screening databases and hospital records were analyzed, comparing the two services wherever possible.More screening data was available from the ODS. ODS: 5706 screened, 3.5% referred. False positives 6.5%, PPV 91.4%, sensitivity 97.9%, and specificity 99.8% for reduced VA. Cost per child with reduced vision detected £195.22, and per amblyope detected £683.28. The mean treatment cost per child with reduced VA was £331.68 and for amblyopia treatment was £458.65.SNDS: 5630 screened and 3.8% referred (plus some referrals to local optometrists lost to follow up). False positives 34%, PPV 53.2%, sensitivity and specificity estimated as 89.3% and 98.67%. Costs to secondary services of false positives were seven times greater. The cost per child with confirmed reduced vision seen at the hospital was 46% more; and per amblyope detected was 39% more.Outcomes for treatment post referral in both groups were similar and excellent. 86% of genuine referrals improved to within normal limits with glasses alone. Of 221 genuine referrals with final outcome data, all now have better than 0.2logMAR acuity in the better eye and only two (0.9%) have residual amblyopia in one eye worse than 0.4logMAR. About 14-18% of children with reduced VA would have passed AAPOS photoscreening referral criteria.An orthoptist-delivered single VA screen at 4-5 years is highly cost effective with good outcomes. The main contributing factors to success appear to be training and experience in accurate VA testing, the opportunity to rescreen equivocal results, and monitoring, audit, and feedback of outcomes.

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Section: Discussionmentioning

confidence: 99%

Costs and effectiveness of two models of school-entry visual acuity screening in the UK

et al. 2021

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“…In the subsequent cleaning stage, records with missing data, cancelled or incomplete sight test components and those pertaining to children with poor concentration were removed. Signi cant refractive error was de ned as myopia or hypermetropia ≥ 1.00 DS; astigmatism ≥ 1.00 DC and/or anisometropia (either spherical or cylindrical) ≥ 1.00D [24,25]. Children without signi cant refractive error and lacking any follow-up appointments were classi ed as false positive referrals.…”

Section: Methodsmentioning

confidence: 99%

“…It is concerning that vision screening is still a post-code lottery in the UK. With children in Scotland receiving an orthoptic delivered "gold standard" service[24,41] while other areas of the UK have no vision screening in place.…”

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confidence: 99%

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Prevalence of Presenting Bilateral Visual Impairment (PBVI) associated with refractive error – Findings from the See4School, Pre-school Vision Screening Program in NHS Scotland

Conway,

Pentland

2023

Preprint

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Introduction: The See4School programme in Scotland is a pre-school vision screening initiative delivered by orthoptists on a national scale. The primary objective of this programme is to identify common visual conditions such as refractive error, amblyopia, strabismus and binocular vision defects. Methods: Retrospective anonymised data from vision Screening referrals in Scotland from 2013-2016 were collected. Children underwent an assessment using a crowded logMAR vision test and a small number of orthoptic tests. Results: During the 3-year period, out of 165,489 eligible children, 141,237 (85.34%) received the vision screening assessment. Among them, 27,010 (19.12%) failed at least one part of the screening and were subsequently referred into the diagnostic pathway, where they received a full sight test. The prevalence of bilateral visual impairment (≥0.3LogMAR), ranged between 1.47% (1.37-1.59) and 2.42% (2.29-2.57). Discussion: It is estimated that up to 2.42% (2.29-2.57) of children living Scotland have poorer than driving standard of vision (6/12) in their pre-school year. Reduced vision has the potential to impact a child’s their day-to-day life including their future educational, health and social outcomes.

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Prevalence of presenting bilateral visual impairment associated with refractive error – findings from the See4School, pre-school vision screening programme in NHS Scotland

Pentland,

Conway

2024

Eye

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Background/objectives The See4School programme in Scotland is a pre-school vision screening initiative delivered by orthoptists on a national scale. The primary objective of any vision screening programme is to identify amblyopia, given the common understanding that this condition is unlikely to be detected either at home or through conventional healthcare channels. The target condition is not bilateral visual impairment, as it is believed that most children will be identified within the first year of life either through observations at home or as part of the diagnosis of another related disorder. This belief persists even though bilateral visual impairment is likely to have a more detrimental impact on a child’s day-to-day life, including their education. If this hypothesis were accurate, the occurrence of bilateral visual impairment detected through the Scottish vision screening programme would be minimal as children already under the hospital eye service are not invited for testing. The overarching aim of this study was therefore to determine the prevalence of presenting bilateral visual impairment associated with refractive error detected via the Scottish preschool screening programme. Subjects/methods Retrospective anonymised data from vision screening referrals in Scotland from 2013–2016 were collected. Children underwent an assessment using a crowded logMAR vision test and a small number of orthoptic tests. Results During the 3-year period, out of 165,489 eligible children, 141,237 (85.35%) received the vision screening assessment. Among them, 27,010 (19.12%) failed at least one part of the screening and were subsequently referred into the diagnostic pathway, where they received a full sight test. The prevalence of bilateral visual impairment associated with refractive error and detected via the vision screening programme (≥ 0.3LogMAR) was reported to range between 1.47% (1.37–1.59) and 2.42% (2.29–2.57). Conclusions It is estimated that up to 2.42% (2.29–2.57) of children living Scotland have poorer than driving standard of vision (6/12) in their pre-school year, primarily due to undetected refractive error. Reduced vision has the potential to impact a child’s their day-to-day life including their future educational, health and social outcomes.

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Scottish Pre-School Vision Screening – First 3 Years of National Data

Cited by 4 publications

References 24 publications

Costs and effectiveness of two models of school-entry visual acuity screening in the UK

Costs and effectiveness of two models of school-entry visual acuity screening in the UK

Prevalence of Presenting Bilateral Visual Impairment (PBVI) associated with refractive error – Findings from the See4School, Pre-school Vision Screening Program in NHS Scotland

Prevalence of presenting bilateral visual impairment associated with refractive error – findings from the See4School, pre-school vision screening programme in NHS Scotland

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